Rosacea

Rebecca Fitzgerald (Dermatologist) gives expert video advice on: What can I do to help prevent rosacea?; What are some of the common rosacea triggers? and more...

What is "rosacea"?

The most common type of acne (what we think of as sort of teenage acne) is referred to as acne vulgaris. There is another very common type of acne called acne rosacea. This doesn't have anything to do with plugged up hair follicles; it's actually sort of born out of your skin type and it's a genetic disorder. In this condition, the blood vessels tend to dilate very, very easily. You sort of have the skin that will flush or blush with the slightest provocation; a sip of wine, a cup of coffee, going out in the sun, or a change in temperature will turn your face beet red.

What causes rosacea?

Rosacea isn't caused by outside factors; rosacea is a genetic thing. You're born with a certain skin type that makes you vulnerable to rosacea. So, there are not causes, but triggers for rosacea. Most of these triggers are things that cause the blood vessels to expand in your skin; things like spicy food and alcohol, and pretty much anything that you might want have at a party. In addition to that rosacea can be caused by stress, lack of sleep, and changes in temperature; a lot of these things aren't always within our control. So, from time to time, your rosacea will flare. For that reason we use certain medications to help control it.

What are the most common symptoms of rosacea?

The most common thing that you'll see in rosacea is redness. Occasionally that will flare into pimples and pustules. There are no blackheads in rosacea, which is the biggest difference between it and acne vulgaris. Instead you see these little superficial pustules or red bumps often right around the mouth and nose. In addition to that, you can get a lot of red rimmed inflammation around your eyes; a condition called blepharitis. Sometimes in older men you can see a condition called rhinophyma, where their nose will become very oily and enlarged, with lot of engorged blood vessels, sometimes becoming twice its original size. This is not something that happens in women, it's a testosterone mediated affect and it is something that is easier to prevent than to get rid of. For that reason it is a wise idea to keep your rosacea under control.

What are some of the treatments for rosacea?

One of the underlying things that trigger flares in rosacea are things that dilate the blood vessels and make them expand in the lower layers of skin. Since rosacea is a genetic thing, and not something that you can cure, we basically just try and control it. The redness in rosacea doesn't respond to medicines; that's something that's more addressed by surgical procedures such as laser. Other than that, the medical things that are used in rosacea are just to keep the inflammation down. You can use some topical medicines to prevent you from ever having flares of acne. Once the acne is there though, you need pills to get rid of the papules and pustules. As a general rule we use both; both the topical things to keep you from needing the pills, and the pills when you have a flare.

Who is most at risk to develop rosacea?

Rosacea is something that is typically seen in very fair skinned individuals. Although it is a sort of genetic kit or something that you have your whole life, it doesn't tend to show up until your 30's, 40's or 50's.

Are there surgical treatments available for rosacea?

There are a couple of surgical treatments that are available for rosacea. The problems associated with rosacea are dilated blood vessels and large oil glands. There are lasers that can target those vascular structures and get rid of the redness. There are also procedures, such as something called photodynamic therapy, that can be targeted against both the blood vessels and the sebaceous glands caused by rosacea.

What is "rhinophyma"?

Rhinophyma is a severe exacerbation of rosacea seen on the nose in middle-aged men. It's a testosterone mediated thing; it doesn't happen to women, and uncontrolled can cause a nose to be twice its original size. Once rhinophyma happens, there are laser treatments that can carve your nose back down, but it's much easier to prevent than it is to treat.

What is a rosacea trigger?

A rosacea trigger is anything that makes your rosacea worse; that makes your face redder, or makes you break out into pimples or pustules.

What are some of the common rosacea triggers?

The most common triggers for rosacea are anything that dilates the blood vessels: stress, certain spicy foods, lack of sleep, changes in temperaure.